Ching Cheung stood at her mother’s bedside, helpless, as their hospice nurse drove away. With waning oxygen levels and gurgling congestion, Ching incessantly called hospice for assistance, however, no one was available. Not long thereafter, Ching’s mother passed away.

While hospice care offers the possibility of a peaceful death, many patients encounter an absence of care rather than “continuous care.” This lack of care suggests that some hospices fall short of nursing attention. At 445 hospices, at least a third of patients die without seeing a nurse in the 48 hours before their death. “The trouble, in part, may be a matter of economic incentives posed by Medicare payment rates. Providing patients with ‘routine’ levels of care…can be very profitable. But providing continuous bedside nursing care…can be a financial and logistical drain for small and midsize agencies.”

Furthermore, many hospices do not have their own medical facilities and are unable to arrange contracts with hospitals for a bed. Some hospitals and care facilities refuse to sign contracts taking hospice patients since it would be more profitable to treat other patients. Consequently, hospices are left without a place to put patients who need inpatient care, and therefore, the need for continuous care thinly stretches hospice nursing staffs.